Knowledge, attitude, practice and perception regarding ...Apr 21, 2020 · routine, study and financial matters, study field work and restrict leisure time of meeting family and relatives

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Knowledge, attitude, practice and perception regarding COVID-19 among students in 1

Bangladesh: Survey in Rajshahi University 2

Authors: 3

1Md. Abdul Wadood, E-mail: [email protected] 4

2ASMA Mamun, E-mail: [email protected] 5

3Md. Abdur Rafi, E-mail: [email protected] 6

2Md kamrul Islam, E-mail : [email protected] 7

4Suhaili Mohd, E-mail: [email protected] 8

4Lai Lee Lee, E-mail : [email protected] 9

2Md. Golam Hossain, E-mail: [email protected] 10

Affiliations 11

1Medical Centre, University of Rajshahi, Rajshahi- 6205, Bangladesh 12

2Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi-6205, 13

Bangladesh 14

3Rajshahi Medical College, Rajshahi-6100, Bangladesh 15

4Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, 16

50603 Kuala Lumpur, Malaysia 17

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Short title: Knowledge, attitude, practice and perception of students regarding COVID-19 19

Corresponding Author: 20

Md. Golam Hossain 21

Professor, Health Research Group 22

Department of Statistics, University of Rajshahi 23

Rajshahi-6205, Bangladesh 24

Email: [email protected] 25

Telephone: +880721750597 26

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28

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All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted April 25, 2020. ; https://doi.org/10.1101/2020.04.21.20074757doi: medRxiv preprint

NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

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Abstract 30

Background: The number of infection and death by COVID-19 has been rapidly increasing 31

since December 2019 in all over the world. Until now, there is no specific treatment or vaccine 32

for this disease; WHO suggests only some protective measures like maintaining social distance, 33

staying home, washing hands with soap or sanitizer, wearing mask etc. The objective of this 34

study was to survey knowledge, attitude, practice and perception regarding COVID-19 among 35

students in Rajshahi University, Bangladesh. 36

Methods: We collected data from 305 students of Rajshahi University for this cross-37

sectional study using mixed sampling from March 11 to March 19, 2020. Frequency distribution, 38

Mann-Whitney and Kruskal-Wallis tests were used in this study. 39

Results: Out of 305 participants, 224 (73.4%) and 81 (26.6%) were male and female students 40

respectively. The study revealed that Rajshahi university students had average knowledge on 41

symptoms, protective way and transmission of COVID-19. Female students were more 42

knowledgeable than male. More than one third of the students had negative attitude to avoiding 43

public transport and going out to public places with friends and family. The practice of students 44

practice during our data collection period and in future was not satisfactory. More than one third 45

of students were not keen to stay at home and avoid going to crowded places. The perception 46

towards COVID-19 was not good; they had no idea whether the outbreak would affect their daily 47

routine, study and financial matters, study field work and restrict leisure time of meeting family 48

and relatives. 49



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Conclusions: We found that general knowledge, attitude, practice and perception of the 50

university students regarding COVID-19 were not satisfactory. This indicated that the situation 51

was worse among common people. In Bangladesh, the number of healthcare providers is 52

insufficient. University students can be employed as potential workforce to create awareness 53

among mass people on prevention of COVID-19. 54

Keywords: University students, Knowledge, Attitude, Practice, Perception, COVID-19, 55

Bangladesh 56

57



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Introduction 58

Novel coronavirus disease 2019 (COVID-19) has appeared as one of the most severe pandemic 59

and fatal disease in human history. It has already affected millions of people, thousands of whom 60

are dying every day creating panic and a global deadlock in all spheres of life. The health 61

authorities in Wuhan City of China found 27 pneumonia cases of unknown etiology on 31 62

December, 2019, and Wuhan's Huanan Seafood Wholesale Market was detected as the source of 63

the infection [1] that turned into an outbreak. On January 9, 2020, the China Government 64

reported that the causative agent of the outbreak was ‘severe acute respiratory syndrome 65

coronavirus 2 (SARS-CoV-2)’. The World Health Organization (WHO) named the virus ‘2019 66

novel coronavirus’ (2019NCV) and termed the disease ‘COVID-19’ [2]. Later, WHO declared 67

the outbreak a Public Health Emergency of International Concern [3]. The Chinese Center for 68

Disease Control and Prevention reported that the fatality rate of diagnosed cases was 2.3%, with 69

an increasing risk in the subjects aged 60 and older (3.6% in subjects 60-69 years old; 8% in 70

subjects 70-79 years old; and 14.8% in subjects aged 80 and older), and those with comorbidities 71

(case fatality rate in healthy subjects was 0.9%) [4]. According to the Corona Virus Resource 72

Centre of John Hopkins University and Medicine, 1,498,833 people were confirmed to contract 73

the 2019NCV by April 9, 2020 in 184 countries and out of them, 89,435 people died [5]. The 74

scenario is changing every day with increase in number of infection and death. 75

Evidences show that mammals and birds are the reservoirs of 2019NCV [6-7]. In Wuhan, the 76

virus attacked only those people who visited the wet animal market and their contacts [8-9] 77

indicating that person-to-person transmission is the likely route for spread of 2019NCV. The 78

virus spreads primarily through droplets of saliva or discharge from the nose of an infected 79



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person when she/he coughs or sneezes [10]. WHO reports that the best way to prevent and slow 80

down the transmission of 2019NCV is to be well informed about it, the disease it causes, and 81

mode of its transmission, and suggests people to wash hands with soap or use hand sanitizers 82

frequently, avoid touching the face, mouth, nose and eyes with unwashed or non-sanitized hands, 83

maintaining social distance, and staying home to remain protected from the infection [10]. 84

Individuals should also practice respiratory etiquette such as coughing and sneezing into a flexed 85

elbow, cover mouth and nose with handkerchief or tissue paper and wearing masks to avoid 86

spreading of the virus [10]. Touching surfaces contaminated with the virus is also a way of 87

spread of 2019NCV that may survive on surfaces for several hours and days [11]. Till now, there 88

is no specific vaccine or medicinal treatment for COVID-19 [10]. The disease is manifested by 89

fever, sore throat and mild to moderate respiratory problems and most cases are cured without 90

any special treatment [10]. It may get severe and life-threatening in people of older age and with 91

comorbidities like cardiovascular disease, hypertension, diabetes, chronic respiratory disease, 92

and cancer [10]. Though the outbreak of COVID-19 is a very recent occurrence, many studies 93

have already been done on it. But, to the best of our knowledge, no study has yet been conducted 94

on it with Bangladeshi population. In Bangladesh, COVID-19 situation is aggravating day by 95

day. As of April 9, 2020, a total of 218 confirmed cases of COVID-19 were detected and 20 of 96

them died [12]. This might be an underestimate, as the facilities of 2019NCV test are very 97

limited here. Bangladesh is an over-populated country with a population density of 976/sq.km. 98

[13], where most of its people do not maintain proper personal hygiene. The situation may turn 99

very serious here. The government and the concerned non-government authorities have taken 100

many measures, though too late and insufficient, to contain the outbreak. Educational 101

institutions, offices and markets have been closed, and the whole country has been put under 102



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lock-down for more than two weeks. The government, non-government, social and professional 103

organizations as well as the print and electronic media of the country is conducting massive 104

publicity on mode of transmission of the virus, and sign-symptoms and measures of prevention, 105

control and treatment of COVID-19. However, there are media observations that a considerable 106

number of people are not following the suggestions properly. It is evidenced from previous 107

pandemics that lack of proper knowledge about the disease is associated with negative emotion 108

among people which can further complicate the attempts of preventing the spread of the disease 109

[14]. Taking the perspective into our consideration, we aimed to assess knowledge, attitude, 110

practice and perception regarding COVID-19 among the students of Rajshahi University who are 111

assets of the nation, and thought to be more knowledgeable and conscious about contemporary 112

happenings in home and abroad. 113

Material and Methods 114

Materials 115

This cross-sectional study was conducted from March 11 to March 19, 2020. Rajshahi University 116

was considered as the target area, and all its students were selected as population for the study. 117

Rajshahi University is the second largest university of Bangladesh with an approximate number 118

of 38,300 students who come here from all over the country for higher education. Our study 119

population comprised of non-medical students. 120

Methods 121

Questionnaire: We developed a questionnaire following the instructions and guidelines of 122

WHO that had five parts: (i) general information of students, (ii) knowledge on COVID-19; it 123

was subdivided into three portions: (a) knowledge on signs and symptoms of COVID-19, (b) 124



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knowledge on the protective ways to prevent COVID-19, (c) knowledge on COVID 125

transmission, (iii) perception about COVID-19; it was subdivided into two portions: (a) 126

perception towards COVID-19, and (b) perception about the impact of COVID-19, (iv) attitude 127

towards COVID-19, and (v) practice regarding COVID-19. The draft questionnaire was sent to 128

some experts and finally it was revised following the experts’ opinions and suggestions. We 129

could not conduct pilot study for post-testing of this questionnaire for shortage of time. 130

Sample size determination: The population size was known (34,300). In such case, the 131

following formula would be appropriate to calculate the required sample for this study: 132

21 Nd

Nn

+= , where n = required sample size, N= population size, and d= margin of error (we 133

have considered d= 0.05) [15]. The formula provided that 396 samples would be sufficient for 134

this study. 135

Sampling and data collection: Mixed sampling was utilized in this study for selecting our 136

required samples. In the first step, we selected three departments from 58 departments using 137

random sampling (by lottery); the departments were: (i) Statistics, (ii) Mathematics and (iii) 138

Physics. In the second step, one academic year was selected randomly from each selected 139

department; these were: (i) second year from Statistics, (ii) first year from Mathematics, and (iii) 140

first year from Physics. In the third step, cluster sampling was used for collecting information 141

from the students of the selected years of the selected departments. Students were taken to a 142

particular class room and briefed about the objectives of the study. Written consents of the 143

agreed students were taken. They were abandoned from using their cell phones, laptops and 144

internet. They filled up the questionnaire in presence of the researchers without discussion with 145

their friends. A total number of 305 students were interviewed using this procedure. We could 146



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interview no more students as the university was closed for COVID-19 outbreak in the country. 147

We decided to complete the study with data from 305 students. 148

Ethics statement: Prior to collecting data, we took ethical clearance from the Ethical 149

Committee, Institute of Biological Sciences (IBSc), Rajshahi University, Bangladesh to study on 150

communicable diseases. 151

Statistical analysis: All collected data were entered into SPSS (IBM, version 21) for 152

analysis. Level of students’ knowledge on COVID-19, and percentage of their perception, 153

attitude and practice based on the selected questions were determined by frequency distribution. 154

The normality of the data was checked by Kolmogorov-Smirnov test. The histogram, the test and 155

graph demonstrated that our data were not normally distributed. We used Mann-Whitney and 156

Kruskal-Wallis (nonparametric) tests to find the significance of difference in number of correct 157

answers between two and more than two groups respectively. Statistical significance was 158

accepted at p < 0.05. 159

160

Results 161

Of 305 samples, 73.4% were male and 26.6% were female students. Their age ranged from 17 to 162

28 years with mean and median ages of 20.66±1.78 and 20 years respectively. More than half of 163

the students (51.1%) came from rural area. Near about 50% fathers and 25.6% mothers of the 164

students were highly educated. 76.1% students came from nuclear family (Table 3). 165

91.8% students answered that fever was a symptom of COVID-19 followed by dry cough 166

(81.3%), difficulty in breathing (78.4%), a general feeling of unwell (77.7%), short of breath 167

(70.8%), headache (55.1%), running nose (54.8%), sore throat (49.8%) and diarrhea (16.4%). 168



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More than 43% reported that chest pain was also a symptom of COVID-19 (Table 2). 97.7% 169

students believed that hand washing with soaps and water could prevent COVID-19 followed by 170

avoidance of touching nose, mouth and eyes with unwashed hands, covering mouth and nose 171

with tissue or handkerchief during coughing or sneezing, wearing clean surgical mask when 172

attacked of respiratory illness (coughing, sneezing and flu), avoiding contact with people having 173

respiratory illness symptoms such as coughing, sneezing and flu, cleaning and disinfecting 174

objects and surface, and always eating fully cooked eggs and meat. Some students had wrong 175

concepts also. 39.7% students believed that eating rice and vegetables could give protection from 176

COVID-19, and another 16.1% students felt no need of maintaining distance from infected 177

persons for protection from COVID-19 (Table 1). 97% students answered that COVID-19 could 178

spread from person to person through coughing or sneezing, from animal to human, through 179

objects contaminated with the virus, and eating not properly handled and cooked wild animal 180

meat and food. More than 84% students had wrong concept that COVID-19 could transmit 181

through touching persons with flu. 52.5% and 10.8% students believed that COVID-19 could 182

spread through water and food, and mosquito bite respectively (Table 1). 183

Table 1: General knowledge on COVID-19 184

What are the signs and symptoms of COVID-19?

Yes, N (%) No, N (%) Don’t know, N (%)

A general feeling of unwell 237 (77.7) 46 (15.1) 22 (7.2) Fever 280 (91.8) 22 (7.2) 3 (1.0) Dry cough 248 (81.3) 44 (14.4) 13 (4.3) Sore throat 152 (49.8) 93 (30.5) 60 (19.7) Short of breath 216 (70.8) 57 (18.7) 32 (10.5) Difficulty in breathing 239 (78.4) 44 (14.4) 22 (7.2) Headache 168 (55.1) 95 (31.1) 42 (13.8) Running nose 167 (54.8) 96 (31.5) 42 (13.8) Diarrhea 50 (16.4) 221 (72.5) 34 (11.1)



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Chest pain 134 (43.9) 129 (42.3) 42 (13.8)

What is the protective way to COVID-19?

Avoid contact with people who have respiratory illness symptoms such as coughing, sneezing and flu

266 (87.2) 36 (11.8) 3 (1.0)

Avid touching nose, mouth and eyes with unwashed hands

296 (97.0) 8 (2.6) 1 (0.3)

Always perform hand washing with soaps and water 298 (97.7) 5 (1.6) 2 (0.7) Always eat fully cook eggs and meat 227 (74.4) 62 (20.3) 16 (5.2) Always eat rice and vegetables 121 (39.7) 146 (47.9) 38 (12.5) Clean and disinfect objects and surface 244 (80.0) 36 (11.8) 25 (8.2) Cover mouth and nose with tissue or handkerchief when cough or sneeze

286 (93.8) 13 (4.3) 6 (2.0)

Wear clean surgical mask when you have respiratory illness symptoms such as coughing, sneezing and flu

280 (91.8) 19 (6.2) 6 (2.0)

Don’t need to maintain distance from infected person 49 (16.1) 248 (81.3) 8 (2.6 Knowledge on COVID-19 transmission

COVID-19 can be spread from animal to human 240 (78.7) 35 (11.5) 30 (9.8) Novel coronavirus can be spread from person to person

296 (97.0) 7 (2.3) 2 (0.7)

A person can get COVID-19 through coughing or sneezing from a COVID-19 person

287 (94.1) 11 (3.6) 7 (2.3)

A person can get COVID-19 through mosquito bite 33 (10.8) 236 (77.4) 36 (11.8) A person can get COVID-19 through water and food 160 (52.5) 107 (35.1) 38 (12.5) A person can get COVID-19 through objects contaminated with coronavirus

238 (78.0) 31 (10.2) 36 (11.8)

A person can get COVID-19 by touching other person with flu viruses and then touching their own mouth or nose

259 (84.9) 32 (10.5) 14 (4.6)

185

Table 2 shows the level of knowledge on COVID-19 among university students. Only 3.9% 186

students gave correct answers of all questions regarding signs and symptoms of COVID-19, 187

while more than 46% students answered 6-7 questions correctly. About half of the students 188

(49.5%) knew the ways of prevention of COVID-19. 35.1% students had knowledge about the 189

possible ways of COVID-19 transmission. 190

Table 2: Level of knowledge on COVID-19 among university students 191



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Question Number of correct answer

Level of knowledge, N (%)

Question Number of correct answer

Level of knowledge, N (%)

What are the signs and symptoms of Covid-19?

0 3 (1.0) What is the protective way to avoid COVID infections?

2 2 (0.3) 1 5 (1.6) 3 5 (1.6) 2 7 (2.3) 4 14 (4.6) 3 13 (4.3) 5 37 (12.1) 4 36 (11.8) 6 97 (31.8) 5 53 (17.4) 7 151 (49.5) 6 82 (26.9) Knowledge

on COVID-19 transmission

1 1 (0.3) 7 62 (20.3) 2 6 (2.0) 8 32 (10.5) 3 31 (10.2) 9 12 (3.9) 4 56 (18.4

5 104 (34.1) 6 107 (35.1)

192

The average number of 5.76±1.76 questions on signs and symptoms, 6.22±0.98 questions on 193

protective way to avoid COVID-19 and 4.89±1.08 questions on transmission of COVID-19 were 194

correctly answered by the participants. Mann-Whitney test demonstrated that female students 195

gave significantly more correct answers to the questions regarding protective way to avoid and 196

transmission of COVID-19 than male students (p<0.05). No significant difference was observed 197

between urban and rural, nuclear and joint family, and among parent’s education levels regarding 198

knowledge on COVID-19 (Table 3). 199

Table 3: Average knowledge on symptoms, protective way and transmission of COVID-19 by 200

different characteristics of participants 201

Characteristics Sings and symptoms, Mean±SD, 5.76±1.76

Protective way to avoid COVID-19, Mean±SD, 6.22±0.98

Knowledge on transmission, Mean±SD, 4.89±1.08

Gender M-W test value=8173n

M-W test value=7587*

M-W test value=7534*

Male, 224(73.4) 5.68±1.79 6.11±1.05 4.80±1.11 Female, 81(26.6) 5.99±1.66 6.48±0.67 5.14±0.96 Original residence M-W test

value=11070n M-W test value=11128n

M-W test value=11570n



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Urban, 149(48.9) 5.69±1.75 6.25±0.98 4.91±1.01 Rural, 156(51.1) 5.83±1.77 6.19±0.98 4.87±1.15 Type of family M-W test

value=79430n M-W test value=8283n

M-W test value=0.948n

Nuclear, 232(76.1) 5.79±1.77 6.20±1.00 4.89±1.07 Joint, 73(23.9)

5.67±1.72 6.27±0.90 4.89±1.11

Fathers’ education K-W test, Chi-square value=1.074n

K-W test, Chi-square value=1.712n


Uneducated, 25(8.2) 5.28±2.23 6.12±0.93 5.28±0.79 Primary, 48(15.7) 5.79±1.69 6.08±1.15 4.71±1.11 Secondary, 86(28.2) 5.92±1.69 6.28±0.99 4.80±1.09 Higher, 146(47.9) 5.74±1.73 6.25±0.92 4.94±1.09 Mothers’ education K-W test,

Chi-square value=3.704n



Uneducated, 36(11.8) 5.22±2.14 6.17±0.91 4.83±1.06 Primary, 65(21.3) 5.94±1.60 6.18±0.97 4.69±1.16 Secondary, 126(41.3) 5.87±1.76 6.22±1.00 4.95±1.09 Higher, 78(25.6) 5.67±1.67 6.27±0.99 4.99±1.00 202

N.B.: SD: Standard deviation; M-W: Mann-Whitney; K-W: Kruskal-Wallis; *: 5% level of 203

significance; n: non-significance. 204

205

82.0% students were afraid to contact people with flu symptoms followed by eating wildlife 206

animal’s meat, going abroad with friends and family, eating raw food, going to crowed places, 207

eating outside food from hawker centers, contacting friends and relatives just coming back from 208

overseas, going out to public places with friends and family, and taking public transport. On the 209

other hand, 41.6% and 30.5% did not like to avoid taking public transport and going out to public 210

places with friends and family respectively (Table 4). 211

Table 4: Attitude toward COVID-19 among university students 212

Level of fearful

Yes No Occasionally

Are you afraid to contact with people who has flu symptoms such as cough, running nose, sneezing and fever?

250 (82.0)

34 (11.1)

21 (6.9)

Are you afraid to eat outside food from 224 (73.4) 63 (20.7) 18 (5.9)



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hawker centers? Are you afraid of eating raw food? 228 (74.8) 62 (20.3) 15 (4.9) Are you are afraid of eating wildlife animal’s meat?

246 (80.7) 46 (15.1) 13 (4.3)

Are you afraid to contact your friends and relatives who just back from overseas?

220 (72.1) 60 (19.7) 25 (8.2)

Are you afraid to go to crowed places? 224 (73.4) 57 (18.7) 24 (7.9) Are you avoiding going out to public places with friends and family?

183 (60.0) 93 (30.5) 29 (9.5)

Are you avoiding going abroad with friends and family?

229 (75.1) 67 (22.0) 9 (3.0)

Are you avoiding taking public transport (e.g taxi, bus, train and airplane)?

148 (48.5) 127 (41.6) 30 (9.8)

213

It was observed that 89.5%, 82.3%, 66.6%, 59.7% and 53.8% students currently had or will have 214

the practice of washing hands frequently, performing healthy lifestyle, taking medicines if 215

necessary, staying home and avoiding crowded places and wearing surgical face masks while 216

going out in public places respectively to avoid COVID-19 attack. More than 39% students had 217

negative practice of not wearing surgical face masks while going out in public places, and 32.1% 218

and 27.2 % students will not like to practice staying at home and avoid going to crowded places 219

and taking medicine if they feel unwell respectively (Table 5). 220

Table 5: Practice toward COVID-19 among university students 221

Practice to avoid COVID-19 Yes No Occasionally Do you wash your hands frequently and thoroughly?

273 (89.5) 18 (5.9) 14 (4.6)

Are you are wearing surgical face mask when out in public?

164 (53.8) 121 (39.7) 20 (6.6)

Will you stay at home and avoid go to crowded places?

182 (59.7) 98 (32.1) 25 (8.2)

Will you take medicine (conventional or traditional medicine) if you feel your body unwell?

203 (66.6) 83 (27.2) 19 (6.2)

Will you perform healthy lifestyle (eat nutritious food, exercise regularly, and get enough of rest or sleep) to maintain your body health and to avoid infection?

251 (82.3) 32 (10.5) 22 (7.2)



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222

Only 21% students showed positive attitude answering all 9 questions correctly, while 36.4%, 223

29.2% and 12.5% students showed positive attitude with correctly answering 7-8, 4-6 and 1-3 224

questions respectively. Proper practices (answering all questions correctly) were found among 225

24% students while 54.1% and 20.4% students provided 3-4 and 1-2 correct answers showing 226

their poor practice (Table 6). 227

Table 6: Level of positive attitude and good practice on COVID-19 among university students 228

Attitude Number of positive answer

Level of positive attitude, N (%)

Practice Number of positive answer

Level of good practice, N (%)

Attitude toward COVID-19

0 3 (1.0) Practice toward COVID-19

0 3 (1.0) 1 5 (1.6) 1 13 (4.3) 2 24 (7.9) 2 49 (16.1) 3 9 (3.0) 3 73 (23.9) 4 22 (7.2) 4 92 (30.2) 5 5 (10.5) 5 75 (24.6) 6 35 (11.5) 7 50 (16.4) 8 61 (20.0) 9 64 (21.0)

229

The average level of positive attitude and good practice among students were 6.40±2.32 and 230

3.52±1.20 respectively. Mann-Whitney test demonstrates that female students (3.86±1.16) were 231

significantly more practicing to avoid COVID-19 than male students (3.39±1.19) (p<0.01), and 232

students coming from rural environment (6.70±2.12) showed more positive attitude than their 233

counterparts (6.09±2.49) (p<0.05). Students living in nuclear family (3.62±1.16) had more 234

practice to avoid COVID-19 than students coming from joint family (3.21±1.28) (p<0.05). We 235

did not find the significance of difference in attitude and practice between other groups (Table 236

7). 237



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Table 7: Positive attitude and good practice of COVID-19 by different characteristics of 238

participants 239

240

Characteristics Attitude , Mean±SD, 6.40±2.32 Practice, Mean±SD, 3.52±1.20

Gender M-W test value=8015n M-W test value=6964**

Male, 224(73.4) 6.33 ±2.21 3.39±1.19

Female, 81(26.6) 6.58±2.62 3.86±1.16

Original residence M-W test value=10110* M-W test value=10868n

Urban, 149(48.9) 6.09±2.49 3.46±1.15

Rural, 156(51.1) 6.70±2.12 3.57±1.25

Type of family M-W test value=8376n M-W test value=6935*

Nuclear, 232(76.1) 6.42±2.29 3.62±1.16

Joint, 73(23.9) 6.33±2.43 3.21±1.28

Fathers’ education K-W test, χ2-value=6.607n K-W test, χ2-value =5.009n

Uneducated, 25(8.2) 7.00±1.78 3.24±1.23

Primary, 48(15.7) 6.94±2.39 3.83±1.16

Secondary, 86(28.2) 6.24±2.44 3.49±1.23

Higher, 146(47.9) 6.21±2.28 3.48±1.19

Mothers’ education K-W test, χ2-value=3.507n K-W test, χ2-value=2.758n

Uneducated, 36(11.8) 6.78±2.09 3.22±1.38

Primary, 65(21.3) 6.65±2.43 3.68±1.17

Secondary, 126(41.3) 6.38±2.19 3.52±1.21

Higher, 78(25.6) 6.05±2.52 3.51±1.13

241

N.B.: SD: Standard deviation; M-W: Mann-Whitney; K-W: Kruskal-Wallis; χ2: Chi-square; *: 242

5% level of significance; **: 1% level of significance; n: non-significance. 243

244

54.1% students felt they were highly exposed to COVID-19, while near about half of the 245

students thought they were not or not at all exposed. More than 36%, 30%, 27% and 6% students 246

were extremely, very, moderately and not at all worried about getting COVID-19 respectively. 247

36.4% and 27.5% students were very and moderately worried about the consequences of getting 248



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COVID-19 respectively. About one-third (32.5%), 37.7% and 22.0% students were very fearful, 249

fearful and slightly fearful respectively of COVID-19. 23%, 27.5%, 26.6% and 23% students felt 250

that COVID-19 outbreak affected their daily routine with great extent, moderately, very little and 251

not at all respectively. Also, 23%, 17%, 22.3% and 37.7% students thought COVID-19 outbreak 252

affected their study with great extent, moderately, very little and not at all respectively. More 253

than 21%, 16%, 19% and 43% students believed that COVID-19 affected financial matters with 254

great extent, moderately, very little and not at all respectively. More than 29% students did not 255

think that COVID-19 outbreak affected their family’s daily routine, while 18%, 30.2% and 256

22.6% students believed that it affected their family’s daily routine with great extent, moderately 257

and very little respectively. About 60% students answered that COVID-19 affected their travel 258

abroad with great extent, while other students thought it had affected their travel abroad 259

moderately (17.4%), little (11.8%) or not at all (11.5%). More than 23% students did not believe 260

that COVID-19 affected their study field works, while more than 33% and 22% students thought 261

it affected their study field works with great extent and moderately respectively. Students 262

believed with great extent (31.1%), moderate (23%), very little (26.9%) and not at all (19%) that 263

COVID-19 restricted their leisure time of meeting friends. They also believed that COVID-19 264

outbreak restricted their leisure time of meeting family and relatives with great extent (28.9%), 265

moderately (23%), very little (18%) and not at all (30.2%) (Table 8). 266

Table 8: Perception of students toward COVID-19 and about its impact 267

Are you highly exposed to COVID-19?

Yes, N (%) 165 (54.1)

No, N (%) 79 (25.9)

Not at all, N (%) 61 (20.0)

Extremely N (%)

Very N (%)

Moderately N (%)

Not at all N (%)



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How worried are you about getting COVID-19?

110 (36.1) 92 (30.2) 84 (27.5) 19 (6.2)

How worried are you about the consequences of getting COVID-19?

96 (31.5) 111 (36.4) 84 (27.5) 14 (4.6)

How is your fear level toward COVID-19?

Very fearful N (%) 99 (32.5)

Fearful N (%) 115 (37.7)

Slightly fearful N (%) 67 (22.0)

Not at all fearful, N (%) 24 (7.9)

Perception about the impact of COVID-19

Great extent

Moderately

Very little

Not at all

The COVID-19 outbreak has affected my daily routine

70(23.0) 84(27.5) 81(26.6) 70(23.0)

The COVID-19 outbreak has affected my study

70(23.0) 52(17.0) 68(22.3) 115(37.7)

The COVID-19 outbreak has affected my financial

65(21.3) 49(16.1) 60(19.7) 131(43.0)

The COVID-19 outbreak has affected my family’s daily routine

55(18.0) 92(30.2) 69(22.6) 89(29.2)

The COVID-19 outbreak has affected my travel abroad

181(59.3) 53(17.4) 36(11.8) 35(11.5)

The COVID-19 outbreak has affected my study field work

102(33.4) 69(22.6) 63(20.7) 71(23.3)

The COVID-19 outbreak has restrict my leisure time of meeting friends

95(31.1) 70(23.0) 82(26.9) 58(19.0)

The COVID-19 outbreak has restrict my leisure time of meeting family and relatives

88(28.9) 70(23.0) 55(18.0) 92(30.2)

269

Discussion 270

The outbreak of COVID-19 in China attracted attention of the whole world including 271

Bangladesh since its early stage. Hundreds of students, businessmen and tourists started to return 272

home from China creating a hue and cry in the country. Soon Bangladeshi people from many 273



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18

other countries started to rush to the homeland. Mismanagement of health check-up, COVID-19 274

test and 14 days quarantine of these home-coming people created a huge debate and became a 275

hot cake for print, electronic and social media. Being comparatively more knowledgeable part of 276

the population, the university students are supposed to have higher level of knowledge, attitude, 277

practice and perception regarding the disease. For that purpose, data were collected from 305 278

students of Rajshahi University. It is reported that adequate knowledge, and positive attitude and 279

perception are related to proper practice [16]. Four types of issues related to COVID-19 were 280

discussed in this study. 281

Knowledge on COVID-19 282

Signs and symptoms: This study revealed that only 3.9% and 10.5% students knew correct 283

answers of all nine and eight questions respectively. This indicates that the students did not have 284

good knowledge about the signs and symptoms of COVID-19. The knowledge level of our 285

students was far below than that of Chinese people [2] and Indian healthcare professionals, 286

students and non-medical healthcare staffs [17]. 287

Protective way to avoid COVID-19: About 40% students thought eating rice and 288

vegetables could prevent COVID-19. Half of the students answered all seven questions correctly. 289

We may consider that the students had good knowledge on the protective ways of avoiding 290

COVID-19 though the level of knowledge was lower than that among Indian healthcare 291

professionals, students and non-medical healthcare staffs [17]. 292

Knowledge of COVID-19 transmission: More than half of the students deemed that 293

COVID-19 could transmit via water and food, and 10.8% students believed that mosquito was a 294

vector of COVID-19. Only 35.1% students answered all the 6 questions correctly. It reveals that 295



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the students had fair or moderate knowledge on COVID-19 transmission. However, it was lower 296

than the knowledge level of healthcare professionals and students but higher than that among 297

non-medical healthcare staffs of India [17]. We found that female students were more 298

knowledgeable than males regarding transmission of COVID-19. Usually females take 299

everything more seriously than males, and they have more curiosity to know anything than 300

males. This might be a reason of difference of the knowledge between male and female students. 301

Same result was observed in Chinese and Indian studies [16, 17]. 302

Attitude 303

WHO suggests people to avoid public gatherings, maintain social distancing and stay home for 304

prevention of COVID-19. This study demonstrates that more than 40% had negative attitude 305

towards the measures. The facts reveal that the students of Rajshahi University did not have good 306

attitude towards COVID-19. Attitude towards COVID-19 among the Chinese people and Indian 307

healthcare professionals, students and non-medical healthcare staffs was very positive [2, 17]. 308

The students coming from rural area showed more positive attitude than urban students. It could 309

not be compared as no similar study is available. 310

Practice 311

About 40% students were not using surgical face masks in public places. Scarcity and higher 312

price of masks might be a reason behind it. More than one-third of students were not interested in 313

staying home and avoiding crowds. In China, almost all people used face masks and avoided 314

public places to prevent COVID-19 transmission [2]. Level of practice of preventive guides was 315

also high among Indians [17]. Usually, practice of personal hygiene is comparatively poor in 316

Bangladesh, such as, only 40% people wash hands with soap and water and only 35% schools 317



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have facilities of washing hands with soap and water [17]. This might contribute to poor practice 318

regarding prevention of COVID-19 among our respondents. The female students coming from 319

nuclear family were more practicing to avoid COVID-19 than males and joint family’s students. 320

A Chinese study supports the finding [16]. 321

Perception 322

Perception towards COVID-19: A considerable number of students thought that they 323

were not exposed to COVID-19. Only a smaller part of them were moderately worried of its 324

infection and consequences, and slightly fearful of it. On the basis of answers of the four 325

questions of this section, we can conclude that the student’s perception towards COVID-19 was 326

not good. No previous study on this issue is available till now to compare our finding. Religious 327

and cultural faiths and views might play role in this regard. 328

Perception about the impact of COVID-19: This study shows that only a smaller 329

portion of students felt COVID-19 outbreak affected their daily routine, study, financial matters, 330

family’s daily routine, study field works, and leisure time. The respondents’ perception regarding 331

impact of COVID-19 was poor. To the best of our knowledge, there is no relevant study either in 332

home or abroad regarding the perception about the impact or consequences of COVID-19. We 333

think, during our data collection period, students had no idea how COVID-19 could affect their 334

life. 335

Limitation of this study: Perhaps, this is the first attempt of survey on knowledge, attitude, 336

practice and perception towards COVID-19 among university students in Bangladesh. This study 337

searched out some alarming facts. However, we had many limitations too. The sample size was 338

small. This cross-sectional study could not look into any change in students’ knowledge, attitude, 339



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21

practice and perception on COVID-19 in course of time. By this time, some new information 340

was got, and new misconceptions and misinformation were publicized, but we could not consider 341

these issues. There are many universities in Bangladesh, but we considered only Rajshahi 342

University students as our sample due to limitation of time and budget. The limitations reveal 343

that more in-depth studies are needed. 344

Conclusions 345

In this study, we examined the students’ knowledge on signs and symptoms, preventive measure 346

and mode of transmission of COVID-19. We found that the general knowledge of the students on 347

our selected issues was not satisfactory. A remarkable number of students had negative attitude 348

towards COVID-19. During the data collection time, students’ practices of avoiding COVID-19 349

were found unsatisfactory. Also, students’ perception about COVID-19 was not good. We may 350

suggest the health authorities of Bangladesh to take necessary steps for improving university 351

students’ knowledge, attitude, practice and perception towards COVID-19. In our country where 352

the number of doctors and other healthcare providers are not sufficient, knowledgeable 353

university students can be employed to create awareness on COVID-19 among mass people. 354

Acknowledgements 355

The authors gratefully acknowledge the authority of the selected departments, University of 356

Rajshahi, Bangladesh for providing information about the students. The authors would also like 357

to express their sincere gratitude to all the participants for proving their information. 358

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